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Pressure Injuries: An Ongoing Challenge in Care Environments

Pressure Injuries: An Ongoing Challenge in Care Environments

As patient age and acuity levels continue to rise, increasing frailty, complex underlying chronic diseases and rising obesity add to the daily challenges faced by clinicians. These challenges include pressure injuries; wounds characterised by localised injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure or pressure in combination with shear.1

Despite advances in surface technologies, education, guidelines and facility-based continuous improvement programmes, pressure injury prevalence and incidence remains high in many care settings. These injuries have a significant humanitarian and economic impact2,3 but are generally considered avoidable4 if pressure, shear, time and microclimate are effectively managed.

1. The pyramid of care

The pyramid of care focuses on key factors that can lead to pressure injury if they are not managed appropriately.

Within the pyramid, interventions should be prioritised towards the factors that can be easily modified but are likely to have the biggest impact on the prevention of pressure injury.

Once interventions focused on the more basic risk factors have been prioritised, such as pressure and moisture, the more complex risk factors can be addressed.

2. Pressure and shear

While pressure may be applied directly to the skin, the effects of pressure are frequently exacerbated by lateral shear forces. This is primarily due to the impact of posture and soft tissue deformation, which result in the compression, distortion and occlusion of small blood and lymph vessels. The interrupted supply of oxygen and micronutrients, combined with the failure to remove toxic metabolites, can potentially lead to tissue ischaemia and irreversible necrotic injury.1

3. How much pressure is safe?

Studies have shown that pressure as low as 6mmHg is sufficient to occlude the microcirculation.5,6 However, there is also an inverse relationship between pressure and time.7

While there is no ‘safe’ pressure for every individual, it is evident that tissue can withstand higher pressure for short periods or lower pressure for longer periods, with muscle being most susceptible to damage.

4. Tissue tolerance

The evolution of a pressure injury also depends upon individual tissue tolerance; this is affected by many physical and environmental risk factors. While the exact importance of most risk factors is yet to be elucidated1 and not all can be modified (such as age and underlying disease), the importance of other factors, such as excess heat and moisture on the skin, has been clearly defined through contemporary research.

5. Tissue environment

If the temperature at the skin rises by just 1°C, the resultant hyperaemic response increases metabolic demand. This increase can occur at a time when the blood supply may be limited by vessel occlusion through pressure and shear. This can be particularly problematic when higher pressure are experienced8, and pressure alone can trigger a temperature rise.9

At the same time, increased heat may trigger a natural sweat response and create a continually moist environment. Moisture reduces the tensile strength of the skin, leading to maceration1 and an increased risk of friction damage.

Prevention begins with the identification of individuals at risk as early as possible in the care pathway, and then taking prompt action to provide the correct intervention1,10 which may include early mobilisation.1

Unfortunately, it will never be possible to address all risk factors. It is, therefore, important to prioritise the interventions most likely to have the greatest impact on clinical outcomes, primarily: pressure, shear and microclimate.11

As a priority, vulnerable patients are typically allocated a therapeutic support surface for their bed and chair. As not all surfaces perform in the same way, and patient tissue tolerance varies, it is important to match the right surface to the right patient at the right time, according to clinical need.1

Whilst the collective features and corresponding performance of a specialised surface vary considerably, all redistribute pressure either by generating a constant low-pressure environment (reactive surface) or by periodically lowering pressure through the deflation of alternating air cells (active surface). In addition, many surfaces also feature in-built microclimate management (low air loss) systems, or can be fitted with a microclimate management coverlet, such as Skin IQ® MCM.

Selecting a support surface

Therapy support surface technologies represent one element of a pressure injury prevention programme. While a pressure redistribution mattress may enable the repositioning regimen to be individualised, regular postural change is still important but not without risk to the patient or the caregiver.

The provision of effective pressure redistribution and microclimate management solutions should be based on a holistic assessment of your patient or resident.

It is important to match product functionality with individual therapy goals, as well as the care environment, to ensure the right surface for the right patient at the right time.

This approach may help to prioritise scare resources and interventions to those who are likely to benefit the most.

Choosing the most effective pressure redistribution and Microclimate management solution should be based on a holistic assessment of your patient or resident.

Please contact your local Arjo representative to find out which solution can be best tailored to your needs.

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Disclaimer

All information is provided in good faith – without warranty of any kind, express or implied – and any use of information or material contained herein is at the users’ sole risk. This blog is for information purposes only and shall not be construed as the giving of advice or making of any recommendation and the information should not be relied upon as the basis for any decision or action. The views and opinions of authors expressed herein do not necessarily state or reflect those of Arjo.

At Arjo, we are committed to improving the everyday lives of people affected by reduced mobility and age-related health challenges. With products and solutions that ensure ergonomic patient handling, personal hygiene, disinfection, diagnostics, and the effective prevention of pressure ulcers and venous thromboembolism, we help professionals across care environments to continually raise the standard of safe and dignified care. Everything we do, we do with people in mind.